SPEX SPEX Assessment Exam 2 — Questions and Answers
Question 1: A patient on warfarin is prescribed trimethoprim-sulfamethoxazole for a UTI. What is the most likely drug interaction concern?
- Decreased warfarin absorption
- Enhanced anticoagulant effect leading to bleeding risk (Correct answer)
- Reduced UTI efficacy due to warfarin interference
- Nephrotoxicity from combined use
Correct answer: Enhanced anticoagulant effect leading to bleeding risk
TMP-SMX inhibits CYP2C9, the primary enzyme metabolizing warfarin, increasing warfarin levels and bleeding risk.
Question 2: Which controlled substance schedule includes drugs with accepted medical use but the highest abuse potential?
- Schedule I
- Schedule II (Correct answer)
- Schedule III
- Schedule IV
Correct answer: Schedule II
Schedule II drugs have accepted medical use but carry the highest abuse potential among approved medications.
Question 3: A patient with CrCl of 30 mL/min is prescribed metformin. What is the most appropriate pharmacist action?
- Dispense as prescribed
- Recommend dose reduction to 500 mg daily
- Contact the prescriber to discuss discontinuation or alternative (Correct answer)
- Add a B12 supplement and dispense
Correct answer: Contact the prescriber to discuss discontinuation or alternative
Metformin is contraindicated when CrCl is below 30 mL/min due to risk of lactic acidosis.
Question 4: Which statement about the Orange Book is most accurate?
- It lists all FDA-approved drugs regardless of therapeutic equivalence
- It identifies drug products with established patent and exclusivity information and therapeutic equivalence ratings (Correct answer)
- It is published by the USP and updates monthly
- It only includes brand-name drug products
Correct answer: It identifies drug products with established patent and exclusivity information and therapeutic equivalence ratings
The FDA's Orange Book (Approved Drug Products with Therapeutic Equivalence Evaluations) lists therapeutic equivalence ratings and patent/exclusivity data.
Question 5: A child weighing 22 kg needs amoxicillin for otitis media. The standard pediatric dose is 90 mg/kg/day in 2 divided doses. What is the correct dose per administration?
- 990 mg (Correct answer)
- 1980 mg
- 495 mg
- 825 mg
Correct answer: 990 mg
90 mg/kg/day × 22 kg = 1980 mg/day ÷ 2 doses = 990 mg per dose.
Question 6: Which type of medication error involves giving a drug to the wrong patient?
- Omission error
- Wrong-patient error (Correct answer)
- Wrong-dose error
- Prescribing error
Correct answer: Wrong-patient error
A wrong-patient error occurs when the correct medication is administered to an unintended patient.
Question 7: Nitroglycerin sublingual tablets should be stored in which type of container?
- Amber plastic bottle with child-resistant cap
- Original manufacturer glass bottle, tightly closed (Correct answer)
- Refrigerated blister pack
- Any airtight plastic container
Correct answer: Original manufacturer glass bottle, tightly closed
Nitroglycerin sublingual tablets are highly volatile and must be stored in their original tightly closed glass container to prevent loss of potency.
SPEX SPEX Assessment Exam 2
A patient on warfarin is prescribed trimethoprim-sulfamethoxazole for a UTI.
What is the most likely drug interaction concern?